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NPI Code Detail

MEDICARE: THAO PHUONG PHAM RPH

MEDICARE: THAO PHUONG PHAM RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist85241CA

General Provider Information

NPI Number : 1285398420
Entity Type Code : Individual
Provider Name (Legal Business Name) : THAO PHUONG PHAM RPH
Provider Business Mailing Address
First Line : 16119 GALLATIN ST
Second Line :
City : FOUNTAIN VALLEY
State : CA
Zip : 92708-1439
Country : US
Telephone Number : 714-369-0734
Fax Number :
Provider Business Practice Location Address
First Line : 3222 UNIVERSITY AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2010
Country : US
Telephone Number : 619-528-1793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2021
Last Update Date : 10/25/2021

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